39397_SPENCE, AL_20040727

LlCAMA / - DREDGE & FILL
GENERAL PERMIT �� Previous prit#
❑New _ Modification ❑Complete Reissue DPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC iG
O Rules attached.
Applicant Name M (0 Project Location: County (01 4r�r
Address_ -Afi 0 rerx I .i r Street Address/ State Road/ Lot #(s)
City f,1AII State ZIP
Phone # ( ) `�( `�� y�' Fax # ( ) Subdivision .J
Authorized Agent City �0{ L ZIP l '�
❑CW ❑EW aPTA [I ES ❑PTS Phone # (,) River Basin
Affected ❑ OEA ElHHF ❑ IH El USA ❑ N/A
AEC(s): Adj. Wtr. Body n''U►^ ✓Ne " {F r P Y+ui (n#�arY unkn)
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
-j
)
(Scale:/JA.,vC
Pier (dock) length
Platform
Finger pi
er(s)
Agent or Applicant Printe)d�� Name {
Signature ** Please read compliance statement on back of permit . *
i ',
Application Fee(s) Check #
Permit Officer's Signature
7 17
issuing Date Expiration Date
Local Planningf urisdiction Rover Fite Name

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules ❑ Other:
❑ Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-395-3900
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

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INTEGRATED PAYMENT SYSTEMS INC. • ISSUER
Greenwood Village, Colorado
N I O N
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08-119538543
82-40/1021
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PAY EXACTLY
PAY TO THE �T ��) TZ PAYMENT FOR/ACCT. H
ORDER OF I, -
�� 7,yZ� P�jRr- ,IE DRESS
PURCHA ,SIGNER FOR DRAWER
S��a / /� i-� �I PURCHASER BY SIGMNG YOU AGREE To THE TERMS ON THE REVERSE SIDE
w.e1.�nn�noo nrnnr anA Oesidn Is a service mark of We�st/e�rn�tllni'oo Holdings. Inc./Payable at Wells Fargo Bank Grand Junction - Downtown, N A. Grant Junction, Colorado
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{FOR A PIER/UNCOVERED EfOAT 4IM
I hereby certify that I own proper; acljacent to_� _
(ti:l e of P ope v 0 wuer)
property lcrzted at-
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on r \ in
(ti�'aterbody) (Town andJori unty)
He has descibed to me, as shown belo,,y, the developrpent he is proposincy at tl a.t
location, and, I have no obje:c6ons to his proposal. I understand (hat a pier/uncoveru{ boat Lir_
must be set back a minimum distance or (I5') from myja ca or riparian access url_fess
waived by me.
I do not wish to waive the sebacd requirement.
:LZ7 I do wish to waive that setback ,e�uirernent•
DESCRIPTION; .N-D/OR DRAyY-LNG OF PRO POSED; DEVELOP_IYM'r_':
(To be filled in by individual proposing devel5pment)
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I herebv cerriFy that I own proper;,, ad"ac-z�nt to �j
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property located a(__ 10
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He has described to me, as shown below, the devcloprheric he is proposinc, at that
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location, and, I have no objections to his proposal. I understand ghat a pier/uncovered 'boat kf-
must be sell back a minimum dis=c✓ of fjl7-Lt—_,j (115') CTomrnv';artaofripadanacc�--ssun
waived by me.
I do not wish to waive-l"CMCIIII.
the sciback re,ul
I do wish to waive that setback re-quLrcrnent.
DES CR=0N A-'N-D/OR DRAWING OF PRO POSF-D; DEVELOP-NEEN-T:
(TO be filled in by fadiv&ual PFVPOR . n d eL ev '(�pmgzzt)
JUL 0 9i2004
Morehead Pity DCM
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Signature
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Telephone Numb�jr-
Date: 7- 7

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